Is ADHD Really a Sleep Disorder?

Written by Christine Case-Lo
| Published on December 18, 2012Medically Reviewed by George Krucik, MD, MBA
on October 12, 2012

Many parents report
sleep problems in their children with attention-deficit hyperactivity disorder
(ADHD), more so than in siblings without ADHD (Marcotte et. al., 1998). Sleep
problems include trouble falling asleep and staying asleep, having very
restless sleep, or snoring and gasping while sleeping. For many years, research
into ADHD has included questions about the prevalence of sleep problems in
children with ADHD symptoms.

ADHD affects between five
and 10 percent of school age children (Biederman, 2005). Greater awareness of
the disorder has led to more research and more effective treatment, but many children
still cope with inattentiveness, hyperactivity, impulsiveness, and lack of
focus. In the past, the diagnostic criteria for ADHD included “restless sleep,”
though the most current guidelines do not include sleep problems. Many health professionals
argue that children with ADHD have more sleep difficulties than those without.

Are children with
ADHD also suffering from a sleep disorder?

Sleep Disorders

Sleep disorders are a
serious health issue. According to the National Institute of Neurological
Disorders and Stroke, as many as 40 million Americans suffer from a long-term
sleep disorder, such as sleep apnea, insomnia, or restless leg syndrome (NINDS).

Sleep apnea is a
pattern of interrupted breathing during sleep, usually caused by pressure on your
windpipe as you relax. It’s often associated with obesity or aging, but can also
occur in children. Snoring, snorting, and gasping during sleep are common
symptoms. The lack of oxygen and constant struggle to breathe during the night leads
to continual sleepiness during the day.

Other sleep disorders
include restless leg syndrome and periodic limb movement disorder. These
conditions cause repetitive jerking movements in the limbs, especially the legs.
These motions can wake you up during the night, leading to fragmented,
unhealthy sleep. Not getting good sleep results in daytime sleepiness,
irritability, depression, and lack of focus.

Sleepiness and ADHD Symptoms

Irritability and lack
of focus—hallmarks of ADHD—are also key symptoms of sleep disorders. Plus, sleepiness
in children can manifest as hyperactivity. Parents everywhere have seen kids
running around frantically when they’re overtired. It may be that the hyperactivity
and constant movement of a child with ADHD is actually a sign of “hypoarousal,”
or daytime sleepiness. Movement is just the child’s way of staying awake (Golan
et. al., 2004).

In several studies of
children and daytime sleepiness, researchers found that children with ADHD were
much more likely to fall asleep if given the chance to take a nap than children
who did not have ADHD symptoms, (Golan, 2004 and Cortese, 2006).

Sleepiness would also
explain why stimulant medications are so effective in treating ADHD. More than
80 percent of those diagnosed with ADHD respond well to stimulant medications
like methylphenidate (Ritalin, Concerta) or dextroamphetamine (Adderall) (Greenhill
et. al., 1999). Just like adults clinging to their coffee to cope with
sleepiness, children who do not get quality sleep can improve their attention
and focus with stimulants.

Could Sleep Disorders Cause ADHD Behavior?

Some researchers suggest
that sleep abnormalities can cause ADHD-like behavior. Large-scale studies using
parent and teacher questionnaires have found a correlation between problematic
sleep, sleep apnea, and ADHD behavior (Gau, 2006). Studies of children have
also found sleep apnea and a high incidence of periodic limb movements (PLM) in
those with ADHD (Golan, 2004 and Cortese, 2006). There are even reports that
children diagnosed with a sleep disorder and ADHD have had treatment for the
sleep disorder and seen a significant improvement in school performance.

It may be that some
patients have been misdiagnosed with ADHD, when in fact they have a sleep
disorder. But not all children with sleep abnormalities have ADHD behaviors,
and not all studies agree on the degree of difference in sleep patterns between
children with and without ADHD. PLM and sleep apnea may simply aggravate ADHD
behaviors by causing chronic sleepiness.

Another theory is that
similar neurochemical pathways cause ADHD and certain sleep disorders. For
example, ADHD and periodic limb movement disorder are both associated with low
levels of dopamine—an important neurotransmitter in the brain (Prince, 2008 and
Ventrungo, 2006). We don’t fully understand how low dopamine levels cause these
conditions, but there may be significant overlap. In one study of 34 children
with ADHD and 32 without, 15 percent of the ADHD children had PLM disorder, but
none of the non-ADHD children did (Golan et. al., 2004).

Larger and more
precise studies are necessary, but there’s evidence to suggest that children with
ADHD should have their sleep evaluated. If problems like snoring, gasping, or
limb movements exist, treating them to allow your child to sleep better may
reduce some ADHD symptoms. Talk to your doctor and ask about a sleep study if
you think your child may have sleep problems.

Healthline’s mission is to make the people of the world healthier through the power of information. We do this by creating quality health information that is authoritative, approachable, and actionable.

Join more than 30 million monthly visitors like you and let Healthline be your guide to better health.